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Writer's pictureMohammed A Rashad

🚨 Nitrofurantoin: Reminder of Pulmonary and Hepatic Risks

Updated: Jul 22

Overview


  • 💊 Broad-Spectrum Antibacterial: Used for adults, children, and infants over 3 months for treating and preventing uncomplicated UTIs or pyelonephritis.

  • 📅 Duration: Treatment lasts 3 to 7 days; some may use a daily dose for recurrent UTIs.


Potential Risks


  • 🫁 Pulmonary Reactions:

  • Acute: Fever, chills, cough, chest pain, dyspnoea, pulmonary infiltration, pleural effusion, eosinophilia.

  • Subacute/Chronic: Documented pulmonary damage.


  • 🩸 Hepatic Reactions:

  • Rare but Serious: Cholestatic jaundice, chronic active hepatitis, autoimmune hepatitis, hepatic necrosis.


Important Update


  • 📅 April 2023: MHRA issued a drug safety update.

  • ⚠️ Alert: Be vigilant for pulmonary and hepatic adverse reactions.

  • 📝 Case Reports: Acute pulmonary damage and respiratory failure reported; another case of long-term pulmonary damage.


Hepatic Reactions


  • 🧐 Vigilance: Monitor for signs of liver dysfunction, especially in long-term use.

  • 🧪 Biochemical Tests: Watch for changes indicating hepatitis or liver injury.

  • Immediate Action: Discontinue nitrofurantoin if hepatitis occurs.


Advice for Healthcare Professionals


  • ⚠️ Caution: Use carefully in patients with pulmonary disease or hepatic dysfunction.

  • 📖 Patient Information: Ensure patients read the leaflet on possible symptoms and seek medical advice if they occur.

  • 🟨 Yellow Card Scheme: Report suspected adverse drug reactions.


Advice for Patients and Caregivers


  • 🫁 Lung Symptoms: Seek medical help if you experience trouble breathing, shortness of breath, lingering cough, coughing up blood or mucus, or chest pain.

  • 🩸 Liver Symptoms: Seek medical help if you develop yellowing of the skin or eyes, upper right abdominal pain, dark urine, pale stools, itching, or joint pain.


Pulmonary Damage


  • Monitoring: Long or short-term use can cause damage; closely monitor especially elderly patients on long-term therapy.

  • 🚨 Action: Discontinue nitrofurantoin immediately if pulmonary damage symptoms occur.

References:


1. MHRA (2023). Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions, Drug Saftey Update. Available at Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions - GOV.UK (www.gov.uk). Accessed 3 April 2024).

2. Summary of Product Characteristics and Patient Information Leaflets. (2024). Nitrofurantoin. Available at https://www.medicines.org.uk/emc/search?q=Nitrofurantoin+ . Accessed 3 April 2024.

3. Yellow Card Scheme (2024). Yellow Card reporting site, Medicines and Healthcare Products Regulatory Agency. Available at https://yellowcard.mhra.gov.uk/. Accessed 3 April 2024.

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